Evaluation of data on surgical complications after cholecystectomy submitted to a nationwide quality assurance program (BQS) in Germany

Background. The BQS is a nationwide quality assurance program in Germany. The aim was to evaluate the data quality on intra-operative and postoperative complications for cholecystectomy submitted to the BQS. Patients and methods. For 205 patients who underwent cholecystectomy in 2007 complications were retrospectively evaluated and compared with those documented in the BQS database. Additionally the risk factors for complications were documented. Results. A total of 205 patients were included in the study. In 88% of patients the operations were initiated as laparoscopy and the conversion rate was 8.3%. Of the patients 28 suffered from intra-operative or postoperative complications. There were no injuries to the ductus hepatocholedochus (DHC).The most common operation-specific complications were disorders in wound healing (n=7). Multivariate analyses resulted in significant increases in complication rates for ASA status (Odds ratio 3.29, 95% confidence interval 2.12-5.10, p<0.01) and acute cholecystitis (odds ratio 7.71,9% confidence interval 2.96-20.08, p<0.01). Only 13 patients out of 28 were correctly documented in the BQS database (p<0.01). Sensitivity and specificity for complications were 46 and 98%, respectively. Conclusions. Less than half of all cases were correctly documented in the BQS database. If documentation inthe BQS database was equally poor for all German surgical departments, neither benchmarking nor general conclusions on quality of surgical care could be drawn from the BQS data.